This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Cirrhosis affects 5.5 million patients in the US. Complications of cirrhosis, including overt hepatic encephalopathy, are one of the leading causes of morbidity and mortality in the US. An estimated 2.1 billion dollars are spent annually in the direct cost of these conditions. Overt hepatic encephalopathy is a neuro-cognitive complication of cirrhosis which is present in up to 41% of cirrhotics and is associated with decreased survival. Minimal hepatic encephalopathy (MHE) is the pre-clinical stage of OHE which is associated with poor quality of life, increased traffic accident risk and impaired driving skills. Although the natural history of OHE has been well described, the natural history of MHE is not well defined. The natural history of MHE is important since there are effective treatments available for it. Driving skills of MHE patients are impaired and retrospective studies have shown a high risk of traffic accidents in MHE. However the driving skills and rate of traffic accidents and violations of patients with OHE have not been described till date. This proposal aims to delineate the natural history of MHE and determine the driving skills of patients with OHE compared to those with and without MHE.